* 


7 


x  v 


the  duties  of  the  local  health  officer. 


BY  HENRY  B.  BAKER,  M.  D.,  SECRETARY  OF  THE  STATE  BOARD  OF  HEALTH, 


A  paper  read  at  the  Hastings  Sanitary  Convention 


Dec.  1888.  Reprinted  from  a  Supplement  to 


the  Annual  Report  of  the  Michigan  State  Board  of  Health  for  the  year 


[Reprint  No.  297.] 


Inasmuch  as  our  health  officers  exist  for  the  purpose  of  protecting  us  from 
dangerous  diseases,  we  may  get  an  idea  of  what  are  them  most  important 
duties  by  finding  out  what  are  the  most  important  dangers  from  which  they 

^In^McMgan  the  five  diseases  which  cause  the  most  deaths  are:  Con¬ 
sumption,  diphtheria,  pneumonia,  typhoid  fever  and  scarlet  fever. 


pas  a- 


54 


HASTINGS  SANITARY  CONVENTION,  DEC,,  1888. 


DIPHTHERIA. 

Concerning  diphtheria,  which  is  next  to  the  most  fatal  disease,  health 
officers  in  Michigan  now  generally  know  how  to  restrict  it,  and  thereby  to  save 
hundreds  of  lives.  If  you  ask  how  do  we  know  that  they  know  how,  I 
reply,  some  of  the  health  officers  in  Michigan  are  doing  this  all  the  time,  and 
we  have  the  facts  to  prove  it;  and  to  prove  how  it  is  done.  For  instance,  in 

1886,  464  outbreaks  of  diphtheria  were  reported  to  the  office  of  the  State 
Board  of  Health,  and  the  health  officers  were  requested  to  report  just  what 
was  done  to  restrict  the  disease,  and  how  many  cases  occurred  in  each  out¬ 
break.  If  under  one  method  of  work  or  neglect  to  work  the  disease  spreads, 
and  under  some  other  method  of  work  the  disease  does  not  spread  from  the 
first  cases  we  can  find  it  out  if  we  devote  sufficient  thought  and  work  to  the 
compilation  of  the  reports  which  the  health  officers  make,  provided  they 
report  the  exact  facts.  I  am  sorry  to  say  that  in  about  240  of  the  outbreaks 
the  health  officers  did  not  report  with  sufficient  accuracy  so  that  we  could 
tell  exactly  what  they  did  do;  but  in  about  200  outbreaks  they  did  report 
distinctly,  and  of  these  about  one-half  had  secured  isolation  of  the  first  cases, 
and  the  thorough  disinfection  of  infected  things,  while  the  other  half  had 
not  secured  both  isolation  and  disinfection,  although  some  of  them  had 
secured  one  or  the  other  of  these  important  measures.  Careful  compilation 
of  all  of  these  reports  showed  that  in  those  outbreaks  in  which  either  isola¬ 
tion  of  the  sick,  or  disinfection  of  infected  places  and  things  had  been  neg¬ 
lected,  the  disease  had  spread  so  that  there  were  about  five  times  as  many  cases 
and  five  times  as  many  deaths  as  there  were  in  those  outbreaks  in  which  both 
isolation  of  the  sick  and  infected,  and  the  disinfection  of  all  infected  places 
and  things  had  been  accomplished.  In  the  116  outbreaks  in  which  all  this  was 
done  there  was  apparently  a  saving  of  about  300  lives  and  1,500  cases  of 
sickness  from  diphtheria.  Of  course  it  is  easy  to  find  fault,  and  to  say : 
“What  a  pity  these  measures  were  not  carried  out  in  all  of  the  461  outbreaks 
instead  of  only  in  the  116,”  but  we  should  not  lose  sight  of  the  fact  that 
there  was  a  positive  saving  of  several  hundred  lives,  in  a  single  year,  from 
one  disease,  and  that  the  compilation  of  the  reports  proved  how  it  was  done 
and  how  it  might  be  done  again,  namely  by  thorough  and  careful  isolation 
and  disinfection  under  the  direction  of  a  capable  and  efficient  health  officer. 
And  now  very  much  the  same  thing  has  been  done  again,  as  is  shown  by  the 
compilation  of  the  reports  of  the  health  officers  in  Michigan  for  the  year 

1887. 


SCARLET  FEVER. 

What  I  have  said  relative  to  diphtheria  is  applicable,  with  slight  variation, 
to  scarlet  fever.  The  compilation  of  the  reports  of  the  health  officers  in 
Michigan  relative  to  scarlet  fever  during  the  year  1886,  showed  that  in  the  58 
outbreaks  in  which  disinfection  and  isolation  had  been  thorough,  the  disease 
had  not  spread  much,  while  in  those  outbreaks  in  which  isolation  or  disinfec¬ 
tion  had  been  neglected,  there  were  over  five  times  as  many  cases  and  over 
five  times  as  many  deaths.  The  compilation  of  reports  relative  to  scarlet 
fever  in  the  year  1887  has  demonstrated  that  the  year  1886  was  not  exceptional, 
the  saving  of  life  and  health  was  again  apparent. 


DUTIES  OF  THE  LOCAL  HEALTH  OFFICER. 


55 


TYPHOID  FEVER. 

The  measures  for  the  restriction  of  typhoid  fever  are  not  the  same  as  for 
diphtheria  and  scarlet  fever,  and  the  evidences  of  success  have  not  yet  been 
soPwell  elaborated,  but  I  feel  confident  that  a  considerable  proportion  of  the 
sickness  and  deaths  from  this  disease  may  be  prevented  by  measures  which  are 
described  in  a  pamphlet,  copies  of  which  are  distributed  in  this  audience. 
Some  of  the  essential  measures  need  the  efforts  of  the  health  officer  to  make 
them  most  effective;  but  in  all  of  these  diseases  the  co-operation  of  the  people 
with  the  health  officer  is  important. 

WILL  IT  PAY  TQ,  HAVE  A  HEALTH  OFFICER? 

It  is  plain,  then,  that  some  of  the  most  fatal  diseases  that  afflict  us  may  be 
in  great  part  prevented,  and  that  much  depends  upon  the  knowledge  and 
efficiency  of  the  local  health  officer. 

It  is  plain,  too,  that  the  measures  by  which  these  diseases  are  prevented 
are  m/those  which  in  old  times  we  associated  with  the  duties  of  the  health 
officer.  The  abatement  of  ordinary  nuisances  should  probably  be  attended 
to  bv  the  health  officer ;  but  the  abatement  of  nuisances  may  have  very  little 
to  do  with  the  prevention  of  diphtheria  or  scarlet  fever ;  while  it  is  certain 
that  isolation  and  disinfection  of  infected  persons  and  things  will  save  lives. 

But  when  the  health  officer  comes  into  very  close  relation  to  cases  of  some 
of  these  dangerous  diseases,  he  must  himself  refrain  from  ^oinf  'h^f  y  t° 
some  child  to  whom  he  may  carry  the  disease ;  and  so  he  must  lose  his  prac¬ 
tice.  He  will  also  lose  much  by  the  antagonism  of  those  whose  movements 
he  will  cause  to  be  restrained.  Consequently,  whenever  there  is  an  outbreak 
of  one  of  these  disease,  if  he  attends  to  his  duties  as  health  officer  it  ^ 
probable  that  he  must  relinquish  his  other  means  of  income  Is ^  the public 
nreoared  to  guarantee  him  say,  ten  dollars  a  day  during  the  outbreak,  is 
the^public  prepared  to  insure  him  against  loss  by  reason  of  his  necessary 
action  as  anP efficient  health  officer?  If  not,  is  the  public  willing  to  g^e  him 
such  a  fixed  salary  as  will  induce  the  health  officer  to  take  his  own  chances 

My  belief  is  that,  except  in  Detroit  and  Grand  Rapids,  there  are  few  if  any 
cities  or  villages  in  the  State  where  these  questions  have  been  properly  met An 
the  interests  of  the  people.  Therefore,  either  the  bealt h 
it  should  be,  as  is  the  case  in  many  places,  or  it  is  what  it  should  be  simp  y 
through  the  public  spirit  or  philanthropy  of  some  physician,  as  I  am  glad  to 
testify  is  the  fact  as  regards  many  of  the  cities  and  villages  in  Michigan. 

Perhaps  you  may  think  I  am  wandering  from  the  subject  of  the  duties  of 
the  health  officer,  and  am  giving  a  rather  broad  hint  as  be »  the s  duties i  of  the 
people  or  their  representatives  to  properly  support  the  health  officer  ,  but  it 
necessary  to  examine  into  the  question  in  some  such  manner,  m  order  to  see 
how  it  is  possible  to  have  a  health  officer  who  can  afford  to  perform  his  duties 
faithfully.  Taking  into  consideration  the  prospective  losses  in  various .ways 
mv  own  view  is  that  no  physician  can  afford  to  file  his  oath  of  office  in  th 
Sty  of  Hastings  unless  he  is  assured  of  a  salary  or.  compensation  averaging  a 
thousand  dollars  a  year.  Can  the  city  afford  to  give  that  much.  Let  us 
examine  into  the  facts. 


56 


HASTINGS  SANITARY  CONVENTION,  DEC.,  1888. 
LIVES  MAY  BE  SAVED  IN  HASTINGS,  AND  MONEY  TOO.  * 


The  population  of  Hastings  is  about  three  or  four  thousand.  If  its  death- 
rate  is  about  the  average,  the  annual  deaths  number  about  sixty.  Then  about 
seven  or  eight  of  these  are  from  consumption,  about  five  from  diphtheria,  about 
two  from  scarlet  fever,  and  about  two  from  typhoid  fever.  These  numbers  may 
not  be  exactly  true  for  last  year,  but  for  a  long  series  of  years  they  are  an 
approximately  true  average.  y 

lJ«r0m^e8^PfienCeJ0fthe  h6alth  0fficers  in  Michigan  during  the  years 
1886  and  1887,  I  have  demonstrated  that  at  least  80  per  cent  of  the  eases  of 
the  sickness,  and  78  per  cent  of  the  deaths  from  diphtheria  are  prevented  by 
those  who  secure,  after  the  first  case  has  occurred,  complete  and  thorough  iso¬ 
lation  and  disinfection,  such  as  an  efficient  health  officer  can  secure  when  his 
people  co-operate  with  him  for  that  purpose.  Therefore  the  lives  of  at  least 
m  H?St!ni8  e.aa  he  saved  each  year,  on  the  average,  from  that 
dreadful  disease  diphtheria.  There  may  be  single  years  when  diphtheria 
com® , to  blastings,  and  then  some  parsimonious  grumbler  might  wish 
to  cut  down  the  salary  of  the  health  officer,  perhaps  after  the  same  health 
officer  had  in  some  way  prevented  the  first  case  being  brought  in  as  for 
instance,  by  preventing  a  public  funeral  over  the  body  of  one  dead  fromdiph- 
tWrt  aDd  krouSht  here  for  burial ;  but  I  think  you  can  be  assured  tha/in 
these  days  of  rapid  transit  and  constant  movements  among  the  people  Has- 

1Sim  0f  havi°g  d,iPhtheria  brought  he're  in  every  year,  and  you 

need  a  health  officer  constantly  on  guard  and  in  close  correspondence  with 
he  central  office  at  Lansing  so  that,  at  a  moment’s  notice,  he  may  take  action 
to  prevent  the  introduction,  or  if  that  is  impossible,  then  to  prevent  the  spread 

of  this  one  of  the  most  dangerous  diseases  to  which  our  children  can  be 
exposed. 

LIVES  MAY  BE  SAVED  FROM  SCARLET  FEVER. 

Then,  too,  nearly  the  same  remarks  apply  to  scarlet  fever  as  to  diphtheria; 
although  m  recent  years  the  deaths  in  Michigan  are  not  so  numerous  Yet 
taking  the  average  of  years  in  Hastings,  at  least  one  death  per  year  from 
scarlet  fever  should  be  saved  by  prompt  and  thorough  action  even  after  the 
disease  has  been  introduced,  and,  of  course,  the  most  important  service  of 
a  health  officer  is  to  prevent  the  introduction  of  such  a  dangerous  disease 


CONSUMPTION  SHOULD  BE  LESSENED. 

Enough  is  now  known  of  the  causation  and  spread  of  consumption  so  that 
this  most  important  cause  of  death  should  be  very  greatlv  lessened :  and  it 
may  be  lessened  by  spreading  among  the  people  information  concern¬ 
ing  its  causes  and  just  how  it  may  be  in  great  part  prevented.  An  intelli¬ 
gent  and  faithful  health  officer  whose  time  was  not  otherwise  demanded  for 
the  prac  ice  of  medicine  to  support  his  family,  might  do  much  to  put  before 
the  people  whom  he  was  adequately  paid  for  guarding,  the  facts  collected  by 
sanitarians  and  State  Boards  of  Health  which  would  enable  the  people  to  guard 
against  this  disease  which  ^  is  so  fatal  to  them  at  those  ages  at  which  they 

abou^tl^a sarn^'number ^of 

-name  of  any  such  other pl£ce may  the  word  Hastings,  wherever  it  occurs,  the 


DUTIES  OF  THE  LOCAL  HEALTH  OFFICER. 


57 


should  be  in  the  prime  of  life.  At  least  one  death  a  year  in  Hastings  should 
be  saved  from  consumption. 

LIYES  MAY  BE  SAVED  FROM  TYPHOID  FEVER. 

**  Some  one,  familiar  with  the  ways  in  which  typhoid  fever  is  spread,  has  said 
that  for  every  death  from  typhoid  fever  some  person  should  be  held  crimin¬ 
ally  responsible.  I  should  not  agree  with  that,  because  I  think  that  among  a 
large  proportion  of  the  people  the  ignorance  which  still  permits  the  disease 
to  spread  should  be  pleaded  in  extenuation.  But  intelligent  health  officers 
can  inform  the  people  under  their  care  how  to  restrict  the  spread  of  typhoid 
fever,  and  how  to  do  many  things  which  tend  to  prevent  the  occurrence  of 
the  first  case  in  a  community.  At  least  one  death  a  year  in  Hastings  from 
typhoid  fever  ought  to  be  prevented ;  and  the  person  saved  would  be  most 
likely  to  be  in  the  middle  age  when  his  work  would  be  most  productive. 

Thus  an  efficient  health  service,  having  thorough  cooperation  of  the  people, 
should  save  in  Hastings  each  average  year,  seven  lives,  five  of  the  persons 
being  children  and  two  grown  persons.  I  do  not  say  positively  that  exactly 
so  many  were  saved  during  the  past  year,  but  I  do  claim,  that,  on  an  average, 
this  number  can  be  and  should  be  saved  over  and  above  what  would  occur 
without  such  effeorts  as  those  I  have  suggested.  I  claim  that  the  health  officer 
should  earn  and  have  a  thousand  dollars  a  year  to  supervise  the  work,  and 
that  all  of  your  people  should  aid  him  whenever  it  is  necessary,  and  that  ex¬ 
penses  should  be  incurred  by  the  city  and  by  individuals  which  might  aggre¬ 
gate  another  thousand  dollars ;  and  that  your  people  would  not  only  save 
those  seven  valuable  lives  of  children  and  friends  most  dear  to  you,  but  that, 
by  this  outlay,  money  in  excess  of  the  outlay  would  actually  be  saved  which 
otherwise  is  lost,  that  is,  if  the  money  were  judiciously  expended  and  you 
secured  the  efficient  service  which  I  have  indicated.  Let  me  point  out  just 
how  some  of  the  saving  would  occur :  — 

THE  MONEY  VALUE  OF  WAGE-WORKERS. 

Political  economists  sometimes  estimate  that  an  average  man  in  the  early 
part  of  the  productive  period  of  his  life  will  afterwards  earn,  over  and  above 
what  it  will  cost  to  support  him,  one  thousand  dollars.  It  is  within  the 
memory  of  some  of  us  that  a  healthy  negro  slave  could  be  sold  at  the  South 
for  eight  hundred  or  a  thousand  dollars,  and  we  will  all  admit  that  slaves  were 
not  the  most  industrious  persons  either.  Now  if  we  save  from  death,  and 
in  good  health,  two  adult  persons  in  Hastings  in  each  year,  we  have  saved 
in  money  value  to  the  families  to  which  those  persons  belong  probably 
the  full  amount  of  the  two  thousand  dollars  a  year,  which  I  advise  you  to 
spend  on  your  health  service.  Then  there  are  the  five  children  which  are 
saved  from  dipththeria  and  scarlet  fever.  They  have  cost  hundreds  of  dol¬ 
lars  for  their  maintenance,  and  if  they  die  all  is  lost,  but  if  their  lives  are  saved 
they  will  soon  reach  the  productive  age.  They  are  worth  to  their  families, 
for  what  they  have  cost  and  will  earn,  say  one-fifth  the  value  of  an  adult 
person — or  another  full  thousand  dollars  which  we  may  look  upon  as  profits 
on  our  two  thousand  dollar  investment.  A  50  per  cent  profit  ought  to  satisfy 
any  taxpayer  in  the  city.  And  if  one  of  these  children  chanced  to  be  your 
own,  or  the  adult,  the  bread-winner  of  your  own  family,  the  argument 


58 


HASTINGS  SANITARY  CONVENTION,  DEC.,  1888. 


should  be  convincing ;  but  there  is  another  alternative  suggestion  which  is 
illustrated  by  a  remark  that  I  recently  heard  at  the  meeting  of  the  American 
Public  Health  Association, — Dr.  Smart,  of  the  United  States  army,  was 
deploring  the  slowness  of  the  people  in  public-health  work,  and  said  there 
was  little  comfort  to  be  had  from  the  thought  that  years  in  the  future  when 
your  name  is  mentioned  some  one  will  say:  “Yes,  I  knew  him  well; 
he  died,  prematurely,  eight  or  ten  years  ago,  of  typhoid  fever.” 
Well,  precisely  that  may  be  said  of  any  one  of  us,  because  the 

safety  of  each  one  is  bound  up  with  that  of  others;  no  man  lives  to  him¬ 
self  alone;  not  only  is  he  his  brother’s  keeper,  but  his  brother,  his 

fellow-citizen,  and  even  a  person  in  a  foreign  land  may  send  him 

something  or  do  that  which  will  endanger  his  life.  In  fact  I  suppose  that 

all  of  our  dangerous  communicable  diseases  are  brought  to  us — we  do  not 
create  them,  and  much  can  be  done  by  ourselves,  by  our  families,  by  the 
community,  and  by  the  health  department  of  our  local  government  (which 
exists  for  our  common  safety  and  welfare)  to  protect  us  from  diphtheria, 
from  typhoid  fever,  and  from  the  other  dangerous  diseases  which  may  be 
prevented  or  restricted. 


